The underlying causes of low back pain can be complex and are not always readily apparent. When determining the underlying cause of lower back pain, two main factors help guide the physician in making a preliminary diagnosis:
- The type of low back pain – meaning a description of how the pain feels, what makes it better or worse, when it occurs, and
- The area of pain distribution – meaning where the pain is felt, if it is confined to the low back, or if the accompanying leg pain is worse than the low back pain, or if the pain radiates elsewhere in the body.
Principles of LumbagoBefore discussing the specific types of low back pain, it is important to understand a few important principles.
- Pain does not always reflect the extent of damage.
The severity of pain from low back problems is often unrelated to the
extent of physical damage present. For example, a simple pulled muscle
in the low back can cause excruciating pain that can limit one’s ability
to walk or even stand, whereas a even a large herniated disc can be completely painless.
- Diagnosis is often difficult. There are many anatomical
structures in the low back that can cause severe lower back pain and/or
pain that radiates into the legs and/or feet. These include:
- Soft tissues, such as muscles, ligaments and tendons
- Bones, which provide the structural building blocks of the spinal column
- Facet joints, which allow the spine move
- Discs (the outer rim of the disc, the annulus, can be a source of significant low back pain due to its rich nerve supply and tendency towards getting damaged)
- Nerves, which branch out from the spinal cord in the low back and innervate the legs and feet
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- Diagnostic accuracy is important. Getting an accurate
diagnosis as to the underlying cause of one’s pain is important if there
are warning signs or “Red Flags” present. These would include weakness
of the legs, significant numbness, loss of bowel or bladder control,
fevers or chills or significant unexplained weight loss. If these
symptoms are not present, then conservative treatment may commence
without the need for obtaining an immediate diagnosis with an MRI.
Next Page: Diagnosing the Cause of Lower Back Pain